Title:Dynamic Change of Neutrophil to Lymphocyte Ratios and Infection in Patients with Acute Ischemic Stroke
VOLUME: 17 ISSUE: 3
Author(s):Lu Wang, Wen Guo, Changyi Wang, Xue Yang, Zilong Hao, Simiao Wu, Shihong Zhang, Bo Wu and Ming Liu*
Affiliation:Department of Neurology, Sichuan University, West China Hospital, Sichuan, Department of Neurology, Sichuan University, West China Hospital, Sichuan, Department of Neurology, Sichuan University, West China Hospital, Sichuan, Department of Neurology, Sichuan University, West China Hospital, Sichuan, Department of Neurology, Sichuan University, West China Hospital, Sichuan, Department of Neurology, Sichuan University, West China Hospital, Sichuan, Department of Neurology, Sichuan University, West China Hospital, Sichuan, Department of Neurology, Sichuan University, West China Hospital, Sichuan, Department of Neurology, Sichuan University, West China Hospital, Sichuan
Keywords:Neutrophil to lymphocyte ratios, infection, pneumonia, prognosis, stroke, biomarkers.
Abstract:
Background: Neutrophil to lymphocyte ratio (NLR) on admission was reported to be a
predictor of pneumonia after stroke. The aim of this study was to investigate the association between
the temporal change of NLR and post-stroke infection and whether infection modified the
effect of NLR on the outcome.
Methods: We enrolled patients with acute ischemic stroke within 24 h after onset. The blood was
collected on admission, day 1, 3, 7 after admission to detect white blood cells (WBC), neutrophils,
and lymphocytes. Primary outcomes included pneumonia, urinary tract infection (UTI), other infection,
and the secondary outcome was 3-month death.
Results: Of 798 stroke patients, 299 (37.66%) developed infection with 240 (30.23%) pneumonia,
78 (9.82%) UTI, and 9 (1.13%) other infection. The median time of infection occurrence was 48 h
(interquartile range 27-74 h) after onset. NLR reached to the peak at 36 h. For all outcomes, NLR
at 36 h after stroke had the highest predictive value than WBC, neutrophil, lymphocyte. NLR was
independently associated with the presence of any infection (odds ratio [OR] 1.11, 95% confidence
interval [CI] 1.05-1.17), pneumonia (OR 1.12, 95%CI 1.05-1.19), but not UTI (OR 0.95, 95%CI
0.89-1.01). Adding infection or the interaction term did not substantially change the OR of NLR
predicting 3-month death (OR 1.09, 95%CI 1.01, 1.17).
Conclusion: Increased NLR around 36 h after stroke was a predictor of infection in patients with
acute ischemic stroke. The increased NLR value was associated with a higher risk of 3-month
death, which was independent of poststroke infection.
